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 Use this checklist to ensure all required forms are completed and returned.  Please complete all forms with the name on your Social Security Card.  List the name of your previous school system if transferring within Georgia.  If you have moved since you completed your online application, please ask for an address change form. The address you use when completing your benefits paperwork must agree with Human Resources’ files.

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 All employees are required to be a member of a retirement system. Many employees will become members of Teachers Retirement System.  Members currently contribute 6% of their gross salary.  Contributions are made on a before-tax basis.  In addition to employee contributions, the Board contributes a percentage of your salary.  Member contributions are refundable, plus interest if employment terminates before retirement. Refunds are subject to tax.

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 Please complete the application for TRS Membership.  You must name at least one primary beneficiary, providing all information on this individual.  Secondary beneficiary information is located on the reverse side of the form.  Previous teaching experience may be listed on the reverse side of form.  Please sign on the “Your Signature” line only.

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Health Insurance The Health Plan offers 3 levels of coverage: Bronze, Silver or Gold Plan All levels offer the same coverage, with the following differences: Monthly premium/cost - Bronze is the least expensive, Gold is the most expensive Monthly premium/cost - Bronze is the least expensive, Gold is the most expensive Annual deductible - Bronze has the highest deductible, Gold has the lowest deductible Annual deductible - Bronze has the highest deductible, Gold has the lowest deductible Base HRA contribution - Bronze offers less HRA dollars (contributions), Gold offers the most Base HRA contribution - Bronze offers less HRA dollars (contributions), Gold offers the most Percentage the plan pays after the deductible is met - Percentage is higher for the more expensive plans Percentage the plan pays after the deductible is met - Percentage is higher for the more expensive plans Office visit co-pays and prescription co-pays are the same across all levels of the plan. Wellness visits (annual physicals) are covered at 100% and do not require co-payments at time of service. Be sure to visit www.BeWellSHBP.com to earn rewards! www.BeWellSHBP.com Verify that your your physicians are in network.

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New Hire Health Insurance Form Enroll / Decline You may enroll yourself and your family in health coverage. Requirements for coverage: Spouse – you must submit a copy of your certified marriage license OR a copy of pages 1 & 2 of your most recent federal tax return, signed by you and your spouse Children – you must submit a copy of each child’s certified birth certificate You may cover your children, stepchildren, or legal children under your health plan only until the end of the month of their 26 th birthday. The children are not required to live with you or attend college full-time.

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 Summary of “Bibb” Benefits  Health Plans offered are the same with all Georgia public school districts, whether you work for Bibb, Houston, Monroe, etc.  Local benefits differ from county to county.  Dental rates reflect $5 being contributed by the District through November 2014. Therefore, 2015 rates will increase by $5.

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Summary of “Bibb” Benefits (continued) All employees are part of the “Cafeteria Plan,” which is authorized by the IRS and allows Bibb to make deductions for the benefits listed →→→→ on a “pre-tax” basis.

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Cafeteria Plan Election Form Complete Front & Back *Sign & Date Form* Spouse may be added to dental & vision. Children and step-children are eligible up to age 19 or 26 if full-time student. Step-children must live with employee 180 days per year. Premiums for semi- monthly employees will be split between both paychecks List at least 1 primary and 1 secondary beneficiary (both must be at least 18 years old)

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These forms must be completed for step-children or full-time college students to be eligible for dental, vision and dependent life coverage. The forms may be downloaded at www.houze.org/bibbschools. www.houze.org/bibbschools

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Important FSA Information  Flexible Spending Accounts brochure explains in detail the tax-advantage of paying your out-of-pocket medical expenses and dependent care expenses with pre-tax dollars.  Flexible Spending Accounts are subject to the Internal Revenue “use-it-or-lose-it” rule.  This is a great tax savings! You can set aside pre-tax money to be used for medical, dental or vision expenses.  You must use the money in the account by the end of the plan year (December 31).

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 Choose Plan 1 (payable to age 65) or Plan 2 (payable for 5 years).  Locate your Annual Salary in the first column to determine the maximum amount for which you qualify. You may choose a monthly benefit lower than your maximum.  Choose Elimination Period - the number of days you must be out of work before you become benefit eligible. You must use sick leave before you receive the disability benefit.  Find monthly premium by following your choices on Rate Sheet.  Maternity Benefits: Paid the same as for an illness.  Pre-existing Condition: Any condition, including pregnancy, for which medical advice, care, diagnosis or treatment was recommended or received, or for which prescription drugs were taken, within 3 months before coverage begins will not be covered for 12 months.  NOTE: If you become eligible to draw social security or retirement while receiving disability, the amount of disability will decrease. This could cause requirement of re-payment of funds already received.  Refer to www.houze.org/bibbschools for more details.www.houze.org/bibbschools Disability Plans

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Evidence of Insurability & Pre-Existing Limitations   If applying for 4Xs or 5Xs life insurance, download the Evidence of Insurability form located under “Forms” “Group Life, Disability, Critical Illness-ING” at www.houze.org/bibbschools.www.houze.org/bibbschools   Read the disability pre-existing limitations.   Your signature will confirm that you have read and understand the information.

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Aflac Cancer and Aflac “Off-the-Job” Accident Plans  Policies are available and pay in addition to your health and disability insurance.  Details are available on the website, www.houze.org/bibbschoolswww.houze.org/bibbschools  Aflac policies must be approved and issued. You are required to complete an application and a deduction authorization form to enroll. You may pick up the forms from the Benefits Department.

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Marketplace Coverage The district is required by the U.S. Department of Labor to provide the above notice. For further details, visit www.HealthCare.gov. www.HealthCare.gov

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Online Benefits System Benefit information is available to be viewed online on the Bibb County School District webpage: www.bibb.k12.ga.us by clicking “For Employees,” then “Online Benefits” located on the main page.www.bibb.k12.ga.us New users will need to use the “Registration” link to create a Login ID and password. Your salary sheet will list your Employee ID number. This application allows you to view: Benefits Tax Withholding Leave Balance Payroll Checks Address Information Year-to-Date Information